2019 Mental Health Week Small Grants Application 2019 Mental Health Week Small Grants Application Form Please complete the online application form below to apply for a 2019 Mental Health Week Small Grant. Before you apply for a Grant, please review and confirm your group or organisation is eligible and meets the selection criteria. Please also read through the event planning guide via https://www.mhct.org/mentalhealthweek/ All Grant applicants must register their 2019 event on the MHCT Mental Health Week event program, visit https://www.mhct.org/mentalhealthweek/mhwregistration/ The 2019 Mental Health Week Small Grants program: opens 9:00am on Monday, 24 June 2019 closes 5:00pm AEST on Monday, 22 July 2019 Eligibility Organisations must have an ABN or be auspiced by an organisation with an ABN, and be undertaking the event or activity in Tasmania. The planning activity must clearly align with the theme for Mental Health Week 2019’.Selection Criteria Small Grants applications will be reviewed and assessed by the MHW Selection Panel. The funding process is competitive and your application will be rated against the following selection criteria. Please also note, your requested funding amount may not be available, and another amount may be allocated, should your Small Grant be successful. Meets all necessary requirements, including incorporating the 2019 MHW theme, Mental Health: We All Have A Role to Play Willingness to explore collaboration and partnership with other organisations/agencies on the event, in particular those targeting the same audience and in the same location Innovation and creativity of the event concept Demonstrated clear targets around population size and audience Demonstrated clear promotional planning and methods General InformationOrganisation/ Group:*Organisation website: Event target Audience*(for example, LGBTI, CALD, youth, rural / remote community) Key contact name:* First Last Contact Email:* Contact Phone Number*Address* Street Address Address Line 2 Suburb Post Code Your MHW EventEvent Name*Please provide the intended name of your event. You can change this via the event registration process later if need be. Event Description*Please provide a brief description of your proposed Mental Health Week event or activity 200 word limitEvent Goals*Describe your event objectives/goals and how you plan to achieve them 200 word limitGrant Amount*Please advise the MHW Small Grant category and amount are you applying for. If you are unsure of which category to select please get in touch either via email on firstname.lastname@example.org or phone on 62249222 $2000 for large scale public events only$1500 for medium scale public events only$1000 for small scale public events only$1000 for large school community events$750 for medium school community events$500 for small school community events$500 for small mental health services events$500 small targeted community group events$750 medium targeted community group events Event start date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*please note, events must be held within the Mental Health Week period 6-12 October . If you intend to have your event directly before or after the week please let us know why (eg. it is school holidays) Event start time* : HH MM AM PM Event end date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Event end time* : HH MM AM PM Is your event on a date outside of MHW? Yes No Can you indicate why it is not being held during MHW?We are a school and students will be on holidaysOur audience is young people/parents so it needs to be in the school termOther reason see below responseOther reason:We will take your rationale into consideration but please note we will give preference to events held during MHW if you do not have a good explanation. Event Location*How many people do you expect to attend your event?*PartnershipsPlease describe any partnerships/collaboration with other organisations or agencies on this event (please provide organisation’s name) 200 Word LimitHow do you plan to promote your MHW event to ensure its success?*How to you plan to promote your MHW event to ensure its success, including targeting community members not already engaged with or linked to mental health services/sector? 100 Word LimitEvent Theme*Describe how your event will incorporate the 2019 Mental Health Week theme, 'Mental Health: We all have a role to play' 200 Word Limit (For more detail on how to incorporate the theme please see the event planning kit via www.mhct.org/mentalhealthweek)Other InformationGrant Evaluation and AcquittalAre you happy to complete the official MHW Small Grant Evaluation and Acquittal form after your event? Yes Public Liability Insurance*Will your MHW event / activity be covered by Public Liability Insurance?YesNoPlease complete the budget template to show the selection panel how your organisation plans to utilise the Grant funds. For example: $200 may be used to cover the costs of advertising the event $100 may be used to pay staff assisting your event $50 may be used to purchase food/drinks for volunteers $400 may be used for venue hire Event Budget*CostFunding SourceItemPurpose Add as many budget lines as you need by pressing the plus icon at the end of the row. Application Compliance and Checklist Please read, and tick all boxes to show you understand and agree to these terms. I have completed all parts of the application form* Yes I have included a budget* Yes I have indicated the Small Grant amount I am applying for* Yes I acknowledge that if I am successful in receiving a Mental Health Week grant I am prepared to stage my event during Mental Health Week (6-12 October 2019) unless otherwise agreed upon with the Mental Health Council of Tasmania* I Agree I acknowledge that if I am successful in obtaining a grant it has been awarded on the merit of this application therefore if there are any changes to my event following submission of this application OR receipt of a MHW grant I will inform the Mental Health Council of Tasmania of these changes as a matter of priority* I Agree I acknowledge that where there are significant changes to my event application the selection panel have the right to review allocation of grant funding based on those changes* I Agree I acknowledge that the selection panel have the right to consider equitable distribution of funds across the state in their assessment of grant applications* I Agree I acknowledge that the selection panel may offer partial funding and/or attach conditions to the allocation of grant funding* I Agree I acknowledge that if my application is successful I will nominate ONE key contact from the event to liaise with the Mental Health Council in relation to event matters* I Agree I acknowledge that if successful I will be required to provide evidence of appropriate acquittal of funding* I Agree I acknowledge that if successful I will be required to evaluate my event and provide a summary of the evaluation to MHCT by no later than the 20th of November 2019* I Agree I acknowledge that if successful in receiving a grant I MUST display the Mental Health Council of Tasmania logo and the State Government logo on promotional material and adhere to the Mental Health Week theme guidelines in the promotion of my event* I Agree Submitting the Grant Application By providing your signature, your organisation is agreeing to the below statements. *Applications that do not sign their application by a representative of their organisation will be deemed ineligible. Applications which are not successful will be notified via email and can be contacted for further information upon request. All applications will be assessed by a selection panel comprising of MHCT Media and Communications Manager, A representative from The Mental Health Drug and Alcohol Directorate and other appropriate mental health sector representatives. Successful Grant recipient organisations will be notified and asked to provide MHCT with an invoice for the Grant amount, plus GST and including your organisation’s banking details. Once this is received the payment will be processed by MHCT by electronic funds transfer. I agree to the above conditions of the application process and can assert that all information provided in this application is true and accurate at the time of submittingPrint Name*Organisation/Group*Date *Please be advised that MHCT will include all grant applicants on the MHCT mailing list to receive updates and information on Mental Health Week The Mental Health Council of Tasmania is proudly supported by the Department of Health, who have provided the available 2019 Mental Health Week Small Grant funding.